Job Description Summary ‎ Formed in 2008 and headquartered in Fort Myers, Florida, with offices in Florida, North Carolina, and Texas, Millennium Healthcare is the largest independent physician group in the state of Florida and one of the largest in the United States. At Millennium Physician Group, our employees are the foundation of our success. Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual and help you grow in your role The Risk Adjustment Provider Educator provides Risk Adjustment education to providers and all support staff through a variety of mediums including direct interactive learning sessions individually or in group settings, written guides and protocols, audits, etc. This role will provide analytical interpretation of Risk Adjustment data to determine areas of focus and improvement opportunities. In addition, this role will facilitate and provide detailed analysis, reporting, training, education, and support to Providers and staff to‎ How will you make an impact & Requirements ‎ Responsibilities • Transforms raw data into actionable intelligence to prioritize provider education and risk adjustment initiatives. • Possesses a proven ability to analyze, report, and provide data insights. • Identifies documentation and coding improvement opportunities and gives guidance around best practice strategies in risk adjustment performance. • Analyzes provider coding patterns and performs follow-up audits post-education to track documentation and coding improvement. • Demonstrates knowledge and an ability to apply coding policies and guidelines to the provider documentation review process. • Possesses excellent attention to detail. • Stays current on applicable documentation guideline changes and rules. • Works effectively and efficiently within a team environment. • Adaptable to shifting priorities and demonstrates a willingness to do what it takes to meet team needs. • Understands and complies with policies and procedures for confidentiality of all patient records, HIPAA, and security of systems. • Promotes Millennium Physician Group’s values. • Build relationships with the clinical and clerical teams to ensure open communication for questions concerning the Risk Adjustment program and its components • Demonstrate excellent guest service to internal team members and patients. • Perform other related duties as assigned. Qualifications • Bachelor’s Degree or equivalent work experience. • 2+ years of experience in training program design and development • 2+ years of experience in risk adjustment and ICD-10 coding in the Medicare Risk Adjustment environment • Certified Risk Adjustment Coder (CRC) or similar. • Possess strong critical thinking and analytical skills and an extensive, in-depth knowledge of the HCC Risk Adjustment models. • Proven ability to analyze data, present results effectively through provider education, and monitor the effectiveness of the education provided. • Strong communication skills. • Intermediate Excel skills (Pivot tables, VLOOKUP, Advanced formulas, etc.) and data visualization skills. • Intermediate Microsoft PowerPoint skills with the ability to transform analytical output into simple-to-understand visuals. • In-depth knowledge of ICD-10-CM diagnostic coding. • Must have excellent time management skills, be highly organized, self-motivated. • Excellent customer service, problem-solving skills, and attention to detail. • The ability to follow through timely on tasks is essential. • Possess excellent written, verbal, and interpersonal communication skills. • Must possess initiative; tact; poise; neat personal appearance; and physical condition commensurate with the requirements of the position. • Project management of multiple initiatives with the ability to prioritize and meet deadlines. • Ability to work independently in a fast-paced, cross-functional environment.

About Us One Medical is a primary care solution challenging the industry status quo by making quality care more affordable, accessible and enjoyable. But this isn’t your average doctor’s office. We’re on a mission to transform healthcare, which means improving the experience for everyone involved - from patients and providers to employers and health networks. Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years. In February 2023 we marked a milestone when One Medical joined Amazon. Together, we look to deliver exceptional health care to more consumers, employers, care team members, and health networks to achieve better health outcomes. As we continue to grow and seek to impact more lives, we’re building a diverse, driven and empathetic team, while working hard to cultivate an environment where everyone can thrive. Program Overview The Advanced Care Partner Program creates a team-care structure to collaborate with PCPs who are managing complex patient panels. The ACP “care team” model pairs a highly clinically experienced provider (ACP) with a PCP to collaborate closely by sharing the care and continuity management of the patient panel. The PCP’s task queue provides the focus of this collaborative platform whereby the Advanced Care Partner devotes their work to keeping all categories within SLAs, provides real time responses to patient messages, follows up with chronic care monitoring and management, and intimately understands the patient panel “as their own”, such that complex patients are known well, medical issues are managed efficiently, highest quality conversations engage patients’ trust, and continuity of care between the patient and two providers is seamless and exemplary. Further, the ACP care-team model promotes career-sustainability, mitigates the potential for decision fatigue, prevents practice isolation, and addresses burn-out risk factors. The program prioritizes well-being and belonging for both patients and PCPs. Advanced Care Partner Role: The Advanced Care Partner is a full-time, remote clinician who works business hours live online with a team of PCP peers, a clinical supervisor, and the Clinical Case Management team of Care Navigators and nurses, as needed, for highly complex cases. The ACP will partner with approximately 5 PCPs and their patient panels, owning these shared panels with longitudinal accountability over time. The ACP is responsible for maintaining task category SLAs, including but not limited to: - Answering clinical questions from patients and engaging in clinical dialogue to complete these conversations. - Clinical decision-making resulting from information coming from messages, lab results, and consults. - Owning medication changes, titrations, and adjustments for chronic conditions as needed. - Providing video visits and phone follow-up care as needed. - Completing clinical paperwork such as disability, FMLA, home health sign-offs. - Attention to closing patient care gaps, creating orders and follow up as needed - Processing Consults and providing related follow up management/care as needed. - Referrals to and collaboration with Clinical Case Management. - Providing urgent visit patient scheduling as needed. - Providing continuity of care longitudinally. - Participating as an active member of the care team including real-time Slack room responses, attending huddles, presenting cases, providing support to CCM team members. Employment type: - 40 hours per week. Business hours schedule; must be able to work in two time zones - Remote live video/phone/slack - Reports to the Medical Director, Advanced Care Partner Program Your Qualifications: - 5+ years experience as an NP/PA - Remote/virtual medical care deep practice experience and proficiency - Experience: chronic disease care management, metabolic disease expertise, patient education skills, CGM and EKG data analysis - Strength: expertise in managing high risk patient caseload - Must be currently licensed in CA You’ll be set up for success if you have: - Excellent communication and interpersonal skills working collaboratively with colleagues - Comfortable and enthusiastic to participate in a team-based care model - Practicing at top of scope; challenging the status quo - Compassionate, culturally-competent motivational style when communicating with patients and skill in navigating difficult conversations - Must be a disciplined self-starter- able to work enthusiastically, creatively, autonomously and efficiently - Prior professional experience working with complex patient populations such as terminally ill, unstable co-morbidities, chronic conditions risk reduction - High Proficiency of technology, keyboarding and data platforms to deliver high quality care - Welcome openness to feedback and reflection to gain productive insight into strengths and growth areas of medical practice and teamwork - The ability to confidently problem-solve, manage and own “outside the box” situations with both patients and colleagues This is a full-time virtual role. One Medical is committed to fair and equitable compensation practices. The base hourly range for this role is $61.00 to $67.50 per hour based on a full-time schedule. Final determination of starting pay may vary based on factors such as practice experience and patient care schedule. For more information, visit https://www.onemedical.com/careers/. One Medical offers a robust benefits package designed to aid your health and wellness. All regular team members working 24+ hours per week and their dependents are eligible for benefits starting on the team member's date of hire: Taking care of you today - Paid sabbatical for every five years of service - Free One Medical memberships for yourself, your friends and family - Employee Assistance Program - Free confidential services for team members who need help with stress, anxiety, financial planning, and legal issues - Competitive Medical, Dental and Vision plans - Pre-Tax commuter benefits - PTO cash outs - Option to cash out up to 40 accrued hours per year Protecting your future for you and your family - 401K match - Credit towards emergency childcare - Company paid maternity and paternity leave - Paid Life Insurance - One Medical pays 100% of the cost of Basic Life Insurance - Disability insurance - One Medical pays 100% of the cost of Short Term and Long Term Disability Insurance In addition to the comprehensive benefits package outlined above, practicing clinicians also receive - Malpractice Insurance - Malpractice fees to insure your practice at One Medical is covered 100%. - UpToDate Subscription - An evidence-based clinical research tool - Continuing Medical Education (CME) - Receive an annual stipend for continuing medical education - Rounds - Providers end patient care one hour early each week to participate in this shared learning experience - Discounted rate to attend One Medical’s Annual REAL primary care conference One Medical is an equal opportunity employer, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities. One Medical participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. Please refer to the E-Verification Poster and Right to Work Poster for additional information.

• Accountable for the day-to-day execution, performance, and continuous improvement of Tuesday Health’s clinical model • Leads clinical and quality operations, overseeing clinical managers and care teams to deliver exceptional patient experience, strong clinical and quality outcomes, and execution of our care model • In close partnership with clinical/provider leadership, drives operational excellence through standardized workflow, onboarding and training, disciplined performance management, and continuous improvement • Serves as a primary liaison to health plan care management teams ensuring effective collaboration, coordinated workflows, and partner satisfaction • Partners with Product, Analytics, Member Services, and Market Operations to optimize systems, tools, and processes that improve outcomes, efficiency, and reliability of care delivery • Provide direct supervision, coaching, and performance oversight to clinical managers, fostering a culture of accountability, teamwork, and excellence • Oversee onboarding and training for care teams and clinical managers, ensuring consistent readiness standards, operating routines, and competency development across new team members. • Lead quality operations, including monitoring and improving adherence to clinical workflows, care standards, and documentation requirements to support outcomes and reduce variation • Ensure regulatory compliance, adherence to clinical guidelines, and best practices in patient care management • Own performance against operational, clinical, and quality goals; implement targeted improvement initiatives as needed • Address escalated operational issues and implement solutions to enhance service delivery and patient outcomes • Establish clear operating rhythms and accountability structures to support consistent execution and team performance

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: As member of the Pricing, Data Analysis and Coding (PDAC) team, the Associate Medical Director DME provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical devices and technology, and acts as a resource to CMS, DMEPOS stakeholders, internal staff, on issues concerning medical device coding and DMEPOS policies. In this role, you will also oversee coding integrity efforts as well as write and revise coding advisory articles with regard to Medicare policy and procedure. Description Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. This role is located at our Government Programs Building at 17 Technology Circle, Columbia, SC OR can be REMOTE in the United States. There will be required travel for this position. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. What You’ll Do: - Supports operations in the form of case review on both medical and regulatory matters. - Develops claim adjudication criteria for situations requiring medical judgment. - Provides input on issues and operational policies, processes, and procedures. - Educates staff and medical community on various aspects of medical policy and program administration. - May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies. - Develops external relationships with the medical community and serves as liaison between these entities and the contractors. - Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. - Conducts research into new or controversial medical procedures and technology. To Qualify for This Position, You'll Need the Following: - Required Education: Doctoral degree Medical Doctor (MD) with current active license to practice medicine. - Required Experience: - Five years post graduate experience in direct patient care. - Required Skills and Abilities: - Excellent verbal and written communication skills. - Excellent customer service, organizational, and presentation skills. - Proficiency in spelling, punctuation, and grammar. - Ability to persuade, negotiate, or influence others. - Ability to work as a team member as well as a leader. - Knowledge of medical and utilization review techniques. - Required Software : Microsoft Office Software - Required License and Certificate: Active state medical license and current board certification in a recognized specialty. We Prefer That You Have the Following: - Certified Professional Coding is preferred - Knowledge of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) - Medicare A/B MAC or DME MAC - Experience working in rehabilitation - Three or more years in the healthcare insurance industry, a utilization form or other administrative experience in a health-related field that involved developing coverage and coding policies and guidelines. - Experience involving development of coverage and coding policies and guidelines under a Medicare program contract is preferred. Our comprehensive benefits package includes the following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. - Subsidized health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service Recognition - National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications. Pay Range Information: Range Minimum  $206,011.00 Range Midpoint  $309,767.00 Range Maximum  $413,523.00 Pay Transparency Statement: Please note that this range represents the pay range for this and other positions that fall into this pay grade.  Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.